Delirium tremens associated with fracture of mandible: Report of A Case

Delirium tremens is a severe state of alcohol-related withdrawal syndrome, which is precipitated in the chronic alcoholic who are suddenly deprived of alcohol because of traumatic injury or other diseases. About 5 % of alcoholics show evidence of severe withdrawal symptoms. Symptoms begin within 1 to 3 days after stopping ethanol intake. These include a state of confusion sometimes accompanied by visual, tactile, or auditory hallucinations. The diagnosis is made when the course progresses beyond the usual symptoms of withdrawal to include confusion, severe agitation, and generalized seizures. The likelihood of developing severe withdrawal symptoms increases with concomitant infections or medical problems, a prior history of withdrawal seizures of DTs, and higher quantity and frequency of drinking. Most periods of severe withdrawal begin and end abruptly, rarely lasting longer than 3 to 5 days. The mortality risk for DTs is quite low but increases with preexisting medical illnesses or organ system failure. We experienced a case of DTs associated with fracture of mandible. The patient was a 36-years-old male who was admitted to our hospital via emergency room after suffering from a traffic accident. He developed DTs 3 days after admission and eventually expired. The report of a case and review of literatures are as follows.

Conservative care of pathologic fracture by osteoradionecrosis of mandible: report of two cases

The main pathogenesis of osteoradionecrosis is the initial radiation cellular kill, plus the progressive tissue hypoxia owing to endarteritis, plus late expressions of lethal mutations in stromal cells. Its treatment comprised (1) avoidance of local physical, chemical & biological irritants, (2) wound irrigation, (3) antibiotics & analgesics, (4) superficial sequestrectomy, (5) hyperbaric oxygen therapy, (6) resection and reconstructive surgery, and (7) supportive therapy for systemic condition. Because of the cumulative effect of radiation therapy, it is important to manage the osteoradionecrosis conservatively & continuously, with emotional & physical support. The authors think that conservative care is more essential to the patient of poor systemic condition, than the aggressive resection & reconstructive surgery. We report two cases of pathologic fracture by osteoradionecrosis of mandible that were cared conservatively in the department of dentistry, Wonju Christian Hospital. The contents of treatment are continuous wound dressing, medications (antibiotics and analgesics) in acute infection, incision and drainage on new abscess, emotional support (stress management), proper nutritional and physical supports (exercise and physical therapy). The prognosis of continuous conservative care is relatively favorable.